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The National Audit Office reports that the incidence of tooth decay among five-year-olds is now gradually starting to get worse. Long-term general improvements in public health are now starting to get worse at the margins, which is a symptom of the lack of registration, because if people are not registered with a dentist, they will not have routine check-ups and the problems will not be spotted early.
A consequence of the lack of preventive work is that the problems build up, and people then need emergency cover, which is far worse for everyone. Yet access to emergency cover is not brilliant either. A recent Which? report found that half of England's dentists were unable to see patients requiring urgent treatment for toothache, and that the majority of the rest would not see them on the NHS. So, half the dentists will not see such patients at all, and the other half will probably ask them to pay, if not through the nose, at least a substantial amount.
"At best, many people needing urgent care are forced to go private, often at considerable cost. At worst, serious problems could go untreated, at significant risk to the general health of individuals concerned."
We have a real problem with emergency access. The Prime Minister has said that the answer to the problem is NHS Direct. The number of calls to NHS Direct about dentistry has risen by three quarters over the past couple of years. That is clearly a symptom not, as the Government's amendment to the motion suggests, of everyone getting a better service, but of far more people having to turn to the hotline number because they cannot get the regular service that they used to have. I have another interesting statistic here, and I apologise if Members know it already: toothache is now the fourth most common reason for ringing NHS Direct. That, too, is a symptom of a system that is not working.
What does NHS Direct have to do to keep the Prime Minister's promise? It has to give the caller the name of a dentist, according to what are called "locally agreed standards", but what does that mean? In a rural area, that means a dentist within 50 miles. That could involve someone making a 100-mile round trip to see a dentist in a rural area, yet it gets a tick in the box for the
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Government's targets. How absurd! We also find that the data on the website might not be accurate or reliable, and that the Government are not checking whether people are getting the service that they need, because they are not following up the inquiries. A person might ring up NHS Direct and be given the name of a dentist, but the Government do not then monitor whether the person is able to access that dentist, whether they actually do so, or whether they register with them.
The Government have said that, because there is a struggle to get enough NHS dentists, they will introduce something called "dental access centres". There are already 40 or 50 of these in various cities, and anyone who does not have a dentist can turn up at one. But are they good value for money? Surely anyone who goes to one because there is nowhere else to go will think so, but is this as good as seeing a dentist regularly? A dentist I spoke to recently told me that, typically, it cost £50 to deal with one NHS patient, while the cost at one of these dental access centres is £160 per patient. So three regular NHS patients could be treated at a surgery for the price of treating one at an access centre. This is a very expensive sticking plaster solution to the underlying problem.
One of the unspoken issues today has been charging for dental treatment. Charging is a central feature of NHS dentistry, unlike in most areas of the NHS, in that people are already paying very large sums of money for their treatment. The Government commissioned a review into charging, which was produced in March 2004. They are still thinking about it. They have had a year, and an election, since then, but they are still not telling us their conclusions. They have promised us a response shortly, and I hope that they will publish not only their response but the review itself.
The danger is that the Government will fill the gap with charges. In other words, they could say, "We've put some money into the NHS. It's not enough. Dentists are going to get less income because they are doing fewer of the unnecessary treatments that they used to be paid for. If their income falls, where is the filling going to come from? The answer is that it is going to come from charges." That is the danger. Will the Minister tell us whether that is the Government's strategy? Charges are not the answer to this problem. We are keen on prevention rather than cure, but charging people the earth will simply put them off.
The central issue now is the new contract for dentists. Current funding rules have resulted in dentists feeling that they are on a treadmill, trying to get through as many patients as they possibly can. If the new contracts are inflexible, however, more dentists will leave the NHS. This is not my scaremongering; the National Audit Office has said that
"given the scepticism of some dentists, compounded by a lack of detail on how the new system will operate, we consider that there is a risk that dentists will reduce their NHS commitments, as they did in the 1990s".
A recent British Dental Association survey found that six out of 10 of the dentists remaining in the NHS are thinking of leaving, and that only a tiny fraction think that, on the basis of the Government's proposals, they would do more NHS work.
Sir Paul Beresford (Mole Valley) (Con): The hon. Gentleman took an intervention earlier in which it was pointed out that many dentists would like to work in the national health service, but have moved out so that they can provide the full spectrum of care. Does he believe that NHS dentistry should provide the same full spectrum of care that a patient would receive from a private dentist?
Steve Webb: My judgment is that the concept of the national health service that we apply elsewhere should also be the starting point for NHS dentistry. In other words, we need to get to the idea that people have a basic entitlement to it. For too many people, that entitlement exists in theory but not in practice, with only half of all adults being registered with an NHS dentist. At the moment, the right to an NHS dentist is like the right to eat at the Ritz; we all have such a right in theory, but in practice we cannot exercise it. If that entitlement were to cover the whole breadth of treatmentsincluding, for example, cosmetic dentistryit could result in a very expensive commitment, but there must be a basic right to core NHS dental services. That must be the principle.
Steve Webb: No, and as the hon. Gentleman will see if he reads the record, that is not what I said. One of the key principles is a foundation entitlement to NHS dentistry services, but as I made clear to his hon. Friend the Member for Mole Valley (Sir Paul Beresford), boundary lines will have to be drawn. As he should know, however, we do not currently have such a core entitlement to NHS dentistry.
When the National Audit Office examined Britain, it found that NHS dental coverage was worse in the north of Englandwe saw an example from Manchester in The Sun. I have therefore taken just one case study of a northern constituency, Cheadle. To find out the level of NHS dental coverage there, I typed "Cheadle" into the national health service website, as any resident might do. It came up with the names of 18 NHS dentists, which I thought was great. The first one, however, was not accepting any new NHS patients for treatment, while the second was offering an emergency dental service only, and accepting no new NHS patients for treatment. Nor was the third accepting any new NHS patients for treatment, and that was the case all the way through to the 18th on the list. So not one of the dentists that the Department's own website came up with was taking NHS patients. How can it be, therefore, that according to the Government amendment, all patients are getting better dental care under this Government?
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To pursue the issue further, our campaigners in Cheadle, led by Mark Hunter, phoned 13 NHS dentists in Cheadle to find out what is behind those figures. The answers are revealing. Based on those calls, their impression is of
There was a sense of being beleaguered, and that the Government were not with them in providing a quality service. Another dentist said that the new contract was at the heart of the problem. Another said he was
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